The first breast augmentation surgery was done over 120 years ago. Today, breast augmentation is still rated as the most popular of all cosmetic surgical procedures in the U.S. According to the American Society of Plastic Surgeons, there were over 286,000 breast augmentations done in 2014 or 1 in every 26 women will have had some sort of breast augmentation done since 1997. The reasons a woman would choose to have breast augmentation include reconstruction post-mastectomy, correction of congenital defects and deformities, or for aesthetic purposes.
Silicone and saline implants were both introduced in the 1960s. In the early 1990s, silicone implants were pulled off the market by the FDA due to reports of leaky implants causing medical problems such as autoimmune disease. They returned to the market in 2006 after numerous studies disproved silicone implants causal link to this disease. Silicone implants are now the more popular of the two implants based on plastic surgeons preferring the results of silicone over saline.
Fat transfer can also be used for breast augmentation. This procedure has become more popular due to the lift on the 20-year moratorium on fat grafting procedures that was put in place by The American Society of Plastic Surgeons in 1987. Fat transfer is viewed as both a low risk and equitable alternative to implants. The downside to this option is that is may take several surgeries to achieve the desired look.
A breast implant is a prosthesis that changes the size, form and texture of a woman’s natural breast. The main difference between a saline and a silicone breast implant is mostly in the feel and look of the implant. Saline implants technically feel like a water balloon and silicone implants feel more like a balloon filled up with Jell-O. There have also been introductions of different shape options for silicone implants that give a more natural slope versus a traditional round implant.
Saline implants are filled with saline solution and were first manufactured by the Laboratories Arion Company, in France, and were introduced as a prosthetic device in 1964. Saline implants do achieve comparable results to silicone implants but are associated with other cosmetic problems such as rippling and wrinkling of the breast skin and accelerated pole stretch. They are also associated with technical problems such as the implant being likelier to be noticed by sight or feel.
There are five generations of silicone implants that are defined by common manufacturing techniques. The first prosthetic silicone implant was invented in 1961 by plastic surgeons Thomas Cronin and Frank Gerow and manufactured by Dow Corning Corporation. Cronin and Gerow’s 1963 implant was the first generation silicone rubber envelope-sac and shaped like a teardrop filled with viscous silicone gel. The second generation had a polyurethane foam coating for the shell of the implant. The FDA reviewed the post surgical data and concluded that this type of implant poses an infinitesimal health risk when a carcinogen named TDA was a produced by-product of the chemical breakdown of this polyurethane foam coating. The third and fourth generations were advances in manufacturing technology. The elastomer-coated shell decreased gel-bleeding and a thicker filler gel was used. Anatomic models were also introduced at this time. Since the 1990s, the fifth generations are made of a semi-solid gel that almost eliminates leakage and the migration of the implant from the pocket.
Prices differ between silicone and saline implants. Saline implants are overall cheaper than silicone implants. The price difference is usually about a thousand dollars, depending on the manufacturer. There is also the anesthesia fee, the operating room fee and the surgeon’s fee. These fees vary from doctor to doctor, state to state and the city in which the procedure is performed. Silicone implants in Houston run between $5,000-$8,000. In Beverly Hills, the price can be in the $10,000 range.
Complications of plastic surgical emplacement of breast implants for either reconstructive or aesthetic procedure run the same risks common to any surgery. Complications and risks specific to implants surgery are anesthesia risks, bleeding, infection, rupture, seroma, capsular contracture and capsule rupture, breast pain, altered sensation, impeded breast-feeding function, visible wrinkles, asymmetry, thinning of the breast tissue, symmastia and unfavorable scarring that may involve repair and revision surgeries based on desired outcomes.
Some women have reported serious connective tissues diseases such as systemic lupus, sclerosis, rheumatoid arthritis and fibromyalgia although medical research can not substantiate these reports.
Incisions are made in certain areas to minimize visible scaring. Incisions are made based on the type of breast implant, degree of enlargement, a patient’s particular anatomy and patient-surgeon preference.
There are three types of incisions: periareolar (around the areola), inframammary (underneath the breast itself) and transaxillary (through the arm pit).
Scaring, and the severity of scaring, depends on a number of patient and surgical factors. Certain ethnicities are more susceptible to scaring. Also, incision sight may be a factor to scaring.
The size of breast implants is usually determined by the patient’s body size, body type and desired look. Larger implants can come with problems down the road. Patients that have larger implants may have problems when they go to breast feed. It is also harder to go from large to small sized breasts and doing so may make it necessary for a patient to require a breast lift or reduction to achieve desired results.
The recovery period is between 3 to 7 days. The patient might feel like they did a hundred pushups, or a really tough chest workout the day before, but they are not in a lot of excruciating pain thanks to the nerve blockers. At two weeks, they can ride a stationary bike. At three weeks, they can go jogging. At four weeks, they can start resuming weights as recommended by the plastic surgeon.
Patients will immediately see a size difference because of the placement of the breast implant. It takes about three months with the assistance of time, gravity and massaging for breasts to settle in. The final results are achieved when the implant stretches out the skin so that the tissue, breast and implant all become one unit.
Breast implants are not designed to last a lifetime. Implants will eventually need to be replaced. Annual exams will help the patient and the doctor evaluate the implants’ integrity. Breasts will change over time due to age, weight fluctuation, hormonal factors and gravity. When these occur, patients often opt for a breast lift or implant replacement to preserve a more youthful appearance and contour.
Breast augmentation remains the most popular form of plastic surgery to this day. With new implant designs and enhanced surgical techniques, breast augmentation surgeries have become mainstream and an accepted part of our society.
Written by the Cosmetic Town Editorial Team- MA
Based on an exclusive interview with Dr. Patrick Hsu in Houston, TX